Provider Demographics
NPI:1821098393
Name:KELLY, ROBERT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2404 EDENBORN AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1817
Mailing Address - Country:US
Mailing Address - Phone:504-833-2225
Mailing Address - Fax:504-832-2253
Practice Address - Street 1:671 ROSA AVE
Practice Address - Street 2:STE.101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2843
Practice Address - Country:US
Practice Address - Phone:504-833-2225
Practice Address - Fax:504-834-1391
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07659R207VE0102X
LAMD07659R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology